MEDICARE: HARVEY BRIAN WOLKOV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	G42995	CA

General Provider Information

NPI Number	:	1164420808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARVEY BRIAN WOLKOV MD

Provider Business Mailing Address
First Line	:	1500 EXPO PKWY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4227
Country	:	US
Telephone Number	:	916-646-8300
Fax Number	:	916-920-4434

Provider Business Practice Location Address
First Line	:	2800 L ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5616
Country	:	US
Telephone Number	:	916-454-6600
Fax Number	:	916-454-6618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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